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Prescriptions for antidepressant
medications for children and teenagers rose substantially during the 1990s.
Even though more and more children
and teens are being treated with antidepressants, the evidence supporting
the use of the newest class of antidepressants in children younger than
15 is "meager. More research is needed to examine the safety and
effectiveness of these medications in children.
The researchers grouped antidepressants
into three classes: selective serotonin reuptake inhibitors (SSRIs), which
include Prozac; an older class of drugs called tricyclic antidepressants;
and "other antidepressants."
From
1988, the year Prozac was introduced, to 1994, prescriptions for antidepressants
increased three- to five-fold. Prescriptions for all three types of medications
rose, but the rise was greatest for SSRIs, which
increased 19-fold.
Although SSRI prescriptions,
which were usually prescribed to treat depression, rose dramatically during
the early 1990s, in 1994, more than half of all antidepressant prescriptions
were for tricyclic antidepressants. And this class of drugs was most often
prescribed for attention-deficit/hyperactivity disorder (ADHD), not depression.
Although tricyclic antidepressants
are recommended as a secondary treatment for ADHD, clinical studies do
not support the use of these drugs in youths with depression.
Another potential problem is
that previous research has shown that many children on SSRIs also receive
stimulant medications, which are often used to treat ADHD. The effectiveness
and safety of this combination in children is unknown.
The expanded utilization of
antidepressants for the management of behavioral and emotional disorders
of youth in the 1990s was prominent. More research is needed to strengthen
the evidence that the medications are appropriate for children and teens.
Given that a large proportion
of children and youths are having their emotional and behavioral problems
treated by primary care physicians rather than psychiatrists, future research
to evaluate the antidepressant prescriptions among the young must consider
the effects of both types of care.
Pediatrics
May 2002;109:721-727
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